Effort aims to ensure those caring for vulnerable people meet heightened requirements

The Minnesota Department of Human Services finished a comprehensive top-to-bottom review of nearly 5,600 high-risk Medicaid providers on time on May 31. Completing the effort is a key part of Minnesota’s plan to stop the federal government from withholding up to $2 billion from its Medicaid program. 

The five-month review required providers to show they met heightened legal and eligibility standards required to operate and serve vulnerable people.

​​“More than 1 million Minnesotans deserve to have confidence and trust in the Medicaid providers they depend on for lifesaving and life-affirming care,” said Deputy Commissioner Shireen Gandhi. ​“We are grateful to the providers who successfully completed the revalidation process and will continue to provide quality care.” 

The department is working with patients, lead agencies and providers to ensure continued access to services.  

Of the 5,583 high-risk providers required to revalidate:  

• 2,061 were revalidated and are continuing to provide Medicaid services without interruption.
• 3,411 were notified they will be disenrolled:
  • 2,491 were due to submissions of incomplete paperwork and documentation.
  • 916 were due to failed verification at site visits.
  • 4 were due to failed background study.
• 111 were removed from review at this time because they are no longer providing a high-risk service.
• 59 were referred to the department’s Office of Inspector General for further review. 

“The paperwork is a critical step,” said Gandhi. “This is just not checking the box. DHS uses the information to check requirements are met. And when we go on site what we see must match what was submitted to us.” 

Common reasons for disenrollment notices included failure to disclose management authority or report change in ownership; failure to report changes in or maintain proper credentials such as liability and surety bonds; failure to provide access; and incomplete applications. 

The state stops payments to providers who receive disenrollment notices. Providers have 60 days to appeal. If a provider submits an appeal and necessary documentation, the state may reinstate the ability to bill for continuity of care. 

​Beginning in January, the department made multiple attempts to contact individual providers – in writing at least three times and through more than 6,500 follow-up phone calls – to remind providers of the timeline, what is required, and why submitting complete information quickly would benefit them and their clients. Information about the revalidation process was also available through weekly virtual meetings, community events, a weekly newsletter, online FAQs, daily virtual technical sessions and other resources. 

​To complete revalidation, providers were required to re-establish the information they provided when they became Medicaid providers. 

The required documentation included:  

• Basic ownership disclosures and location and contact information for the business or organization.
• Correct and current licenses, proof of insurance and training to provide care. 
• Showing that the required number of qualified service providers are in place to carry out the work​.
• The process also included fingerprint background studies for owners and an unannounced on-site visit to verify submitted information. 

Ensuring continued access to Medicaid services  

While providers may appeal, the disenrollments mean some Minnesotans will need to change the way they access Medicaid services.

Over several weeks, the state has worked with lead agencies, including counties, Tribes, and managed care plans, to make sure they know which providers were disenrolled. These partners will be responsible for ensuring service continuity and helping their clients find new providers if necessary.   

“Minnesota counties are the first point of contact for most Minnesotans who receive Medicaid services, so while the revalidation process has been a state responsibility, counties are actively responding to questions from clients and even providers who have been disenrolled,” said Julie Ring, executive director for the Association of Minnesota Counties. “We appreciate the engagement with DHS during this process and counties are committed to working in partnership with DHS to ensure continuity of care for all Minnesotans statewide.” 

The department is also reaching out directly to Minnesotans who do not have case managers and who receive services from providers who may be disenrolled.  

A new webpage helping Minnesotans find care lists resources for people who need to connect to new services.   

“Revalidation is a difficult process for everyone involved. NAMI Minnesota supports both legitimate providers and DHS as they work through it, keeping focus on what matters most: ensuring Minnesotans living with mental illness and their families continue to receive the care and support they need. We see this as an opportunity to build a stronger, more reliable system for everyone -- and that work must take every precaution to ensure no disruption for people who depend on these services,” said Marcus Schmit, executive director of NAMI Minnesota. 

Rebuilding trust in Minnesota Medicaid  

Newly signed legislation will increase staffing for the Office of Inspector General at the Minnesota Department of Human Services and create a new statewide Office of Inspector General to oversee all agencies. In addition, the Minnesota Attorney General’s Office will receive funding to expand its Medicaid Fraud Control Unit. 

“Minnesotans deserve to trust that businesses receiving Medicaid dollars are legitimate and properly credentialed, and that they provide quality care,” said Human Services Inspector General James Clark. “We’re not just resetting expectations for providers, we’re also establishing a baseline for building back public trust.” 

The revalidation effort builds on other measures to tighten oversight of Medicaid, including enhanced pre-payment review for high-risk providers, a temporary freeze on new provider enrollment in high-risk programs, and auditing and implementing provisional licensure for autism service providers.  

Learn more about the Minnesota Department of Human Services’ Medicaid program integrity work online.

Editor's note: The quote from NAMI Minnesota's executive director was updated to include "that work must take every precaution to ensure no disruption for people who depend on these services.”